Dr. Stephen Boyce/Knoxville, TN

[DSRIGGS]

Thank you guys! I appreciate the info! Dr. Housten does the DS.....no BPD. He did say he would rather sleeve someone and DS them later for non complience than to just DS them in the beginning. He anticipates a lot of DS revisions after sleeve fail from all the patients he's operating on now. I feel confident he will do a good job. He asked me how long I wanted my common channel and suggested 100cm. But I was leaning toward a little longer like the 120-150 range. What about your AL and how can you answer either question without knowing the length of your small intestine. What if your small intestine is 750 CM and he makes your CC 125 CM and your AL 150 CM? That means that the absorbing portion of your small bowel will only 275/750 = 37% of your intestine absorbing. Your AL + CC should = the BPL or you will likely have malabsorbtion. Please read Dr K's blog on the topic of percentage of total SBL based CC & AL lengths.

http://www.dssurgery.com/blog/bowel-length-in-duodenal-switch/

Have any of you tried the Barilife vits?? I'm interested in the powder version? A friend of mine and fellow DS'r swears by it. Trying to plan ahead and decide on what vit regimen I'd like to try post op. Thoughts? Advice? I've looked at vita lady, but I'm a person that struggles with pills. It's such a battle for me to take my daily reginmen now because I get sick.

 

[DSRIGGS]

I have been getting confused in my research on this point as well! After SouthernLady mentioned Dr. Boyce in Knoxville I was reading on his website and found it VERY confusing. Under the tab "WLS options" it shows (if I am remembering correctly) BPD, BPD with DS and DS??? along with all the others. From reading on here from people who have had him as a surgeon, when they say DS it's the full DS with the sleeve stomach (that leaves pyloric intact) and shortened other stuff (that was technical, huh?). Why in the world would they keep the wording so confusing on the sight?

Also in my reading here of the back threads I saw someone wondering aloud if BLIS insurance covered DS anywhere. According to my reading on Boyce's site it sounds as if BLIS coverage is included in the $25,750.00 quoted there as a pre-pay amount. What I wasn't sure about was whether a program fee that I saw mentioned was something above and beyond this $25,750.00 or if it was included. I haven't made any calls to anyone's office yet as I'm still doing my own research to know what I do want and need to ask when I do talk to someone.

Other things I will find out are whether he uses the Hess method in determining length to use and if he'll consider me for DS. From the voices of experience here, I'm very interested in hearing if Hess method is best. If a surgeon does NOT use that method to determine length what does he use...a set one size does all, or take into account background history, lifestyle, etc? I started to say "his gut feeling" but decided not to"!

The ease of having a surgeon stateside, even within approximately 130 miles of home sounds really great, but the monetary aspect is huge too. I know Ungston is no longer doing the DS but it sounds like Dr. Esquerra is doing well and the difference would be at least 10k. Does anyone have any info to the contrary of Dr. Esquerra doing commendable work?

I've been trying to go through the back posts and find answers to questions and I do apologize if I'm asking things that have been asked a million times. I'm not the greatest at navigating the board yet. I do appreciate the expertise here and everyone's willingness to help.

Read my story if you have any doubt of whether or not the hess should be done rather than an arbitrary cookie cutter length.....yes I had the cookie cutter and have suffered with terrible malnutrition and had to be revised to have both my AL & CC lengthened. I am 100% against any surgeon not using the Hess Method. Why? The quality of my life has sucked for the 2.25 years because of malnutrition and its impact....I am still struggling even after being revised and I firmly believe that had the Hess Method been followed by my original surgeon that I would weigh 20 pounds more right now and have not had this major struggle that I am still fighting to overcome (My nutritional numbers were okay last lab draw but I am not gaining weight and I am having bad abdominal issues again which I believe to be an adhesion from multiple surgeries or another intestinal hernia).

 

[duh_Mom]

I recently had surgery with Dr. Boyce - 6 months ago and he did not do the Hess Method. My cc is 100.

The BLIS insurance is actually included in the money you pay them. It is to cover any surgical complications for the first year. The office called me just before surgery and asked if I wanted to add on BLIS coverage for strictures or pulmonary embolism.

I did have a surgical complication 2 days out from surgery. I was still in the hospital when I had to return to surgery. Dr. B called it an incarcerated hernia. several months post-op I am trying to explain to the office manager that it was not a hernia repair but a complication of the surgery. My bowel got sucked up into one of the trocar holes - she just did not understand - kept calling it a hernia. Anyway, she said she would talk to Dr. B about it. He understood and they wrote off the charges as well as the co-pay for my lap-band removal.

Also, know, that even though I was self-pay I got bills for cardiologist that read EKGs, and Radiologist that read CTs. etc. just kind of a hassle dealing with the bills I did not expect.

 

[Susan in Tennessee]

I recently had surgery with Dr. Boyce - 6 months ago and he did not do the Hess Method. My cc is 100.

The BLIS insurance is actually included in the money you pay them. It is to cover any surgical complications for the first year. The office called me just before surgery and asked if I wanted to add on BLIS coverage for strictures or pulmonary embolism.

I did have a surgical complication 2 days out from surgery. I was still in the hospital when I had to return to surgery. Dr. B called it an incarcerated hernia. several months post-op I am trying to explain to the office manager that it was not a hernia repair but a complication of the surgery. My bowel got sucked up into one of the trocar holes - she just did not understand - kept calling it a hernia. Anyway, she said she would talk to Dr. B about it. He understood and they wrote off the charges as well as the co-pay for my lap-band removal.

Also, know, that even though I was self-pay I got bills for cardiologist that read EKGs, and Radiologist that read CTs. etc. just kind of a hassle dealing with the bills I did not expect.

I thought it sounded like the Blis was included. So, it sounds like getting him to use the Hess method to calculate lengths probably isn't an option? Did you ask him about it beforehand?

 

[Susan in Tennessee]

Read my story if you have any doubt of whether or not the hess should be done rather than an arbitrary cookie cutter length.....yes I had the cookie cutter and have suffered with terrible malnutrition and had to be revised to have both my AL & CC lengthened. I am 100% against any surgeon not using the Hess Method. Why? The quality of my life has sucked for the 2.25 years because of malnutrition and its impact....I am still struggling even after being revised and I firmly believe that had the Hess Method been followed by my original surgeon that I would weigh 20 pounds more right now and have not had this major struggle that I am still fighting to overcome (My nutritional numbers were okay last lab draw but I am not gaining weight and I am having bad abdominal issues again which I believe to be an adhesion from multiple surgeries or another intestinal hernia).

Thanks for sharing, and I will read your story.

 

[duh_Mom]

@Susan in Tennessee, I did not actually. My first appointment with him was a consult to see if there was anything surgical or non-surgical that could be done for me. I did not know a the difference between a DS, RNY or blue moon at that point. He explained the DS to me and answered my questions about it. I was really against it initially because of the severe malnutrition, but I did not make a decision at that point - but came home and started reading and learning.

I did not see him again until surgery day, roughly 7 months later.

I never really thought about asking about the Hess Method - and will be interested in the response you get.

I continue to learn about this surgery and know how very lucky I am that I just happened to walk into Dr. B office to ask about options.
when I had the lap-band in 2006ish, I wanted Dr. B then, but he practiced at the hospital where I worked and did not want people to know what I was having done.

He moved to Tenovva where he is now and I had changed jobs and got over people knowing I was having surgery. I was pretty sure they could tell I was morbidly obese - so went to him. As things worked out, it is very clear to me the 'force' was directing me where I needed to go and taking care of me.

 

[SJB41976]

I thought it sounded like the Blis was included. So, it sounds like getting him to use the Hess method to calculate lengths probably isn't an option? Did you ask him about it beforehand?

I asked specifically about the Hess method. He explained why he doesn't do it (the average person doesn't need their entire intestines measured). All I could think of was, "well, what if I am one of those abnormal people...". He said because lengths vary it is better to do an average rather than entire measuring. I asked specifically if he stretched in any way before measuring and he said no, absolutely not. I'm thinking even if he doesn't technically use the Hess method he eye balls it because he does make different people at different lengths. If you are a "normal" you get 100.

I really don't know. He hasn't had any deaths and he stated 1% complication rate and that was from non-compliant people (of vitamins and protein). He has done over 1,000.

 

[SJB41976]

Also, know, that even though I was self-pay I got bills for cardiologist that read EKGs, and Radiologist that read CTs. etc. just kind of a hassle dealing with the bills I did not expect.

was this due to the complication, the extra stuff?? Why wasn't it covered?

 

[Clematis]

None of the US surgeons I contacted included this @SJB41976 They gave me orders for the different specialists I was required to see and it was my responsibility to make the appointments and pay. Even the nutritionists sessions were extra. The fee only included, doc, anesthesia and hospital

 

[DSRIGGS]

I asked specifically about the Hess method. He explained why he doesn't do it (the average person doesn't need their entire intestines measured). All I could think of was, "well, what if I am one of those abnormal people...". He said because lengths vary it is better to do an average rather than entire measuring. I asked specifically if he stretched in any way before measuring and he said no, absolutely not. I'm thinking even if he doesn't technically use the Hess method he eye balls it because he does make different people at different lengths. If you are a "normal" you get 100.

I really don't know. He hasn't had any deaths and he stated 1% complication rate and that was from non-compliant people (of vitamins and protein). He has done over 1,000.

Sorry but that is flat out BS he is feeding you and in my opinion lazy arrogance on his part that can cause a patient severe health consequences down the line. Because small bowel lengths vary is EXACTLY WHY HE NEEDS TO MEASURE AND FOLLOW THE HESS METHOD.

Two assumptions that you are making that I disagree with:

1. You can't eyeball and guesstimate the length of the small bowel..If you have you ever seen what the small intestine looks like crammed inside the body you will immediately see why.
2. The comment about not having any deaths and 1% complication rate....first off you aren't going to die on the table because a surgeon didn't do the hess. Regarding stated non compliance, I was told I needed to eat more protein when I was protein deficient even though I was eating 150-250 grams of protein a day. Frankly my surgeon's office was too effing out in la la land to even tell me that my total protein and albumin were less than 2/3 of the minimum range, even though I was in the hospital. The impact of having too short of an AL + CC relative to the BPL is malnutrition and it shows up later down the line. Not immediately.

I am also told it is extremely difficult to not stretch the small bowel when measuring.

As Dr K told me, the guys who don't measure the small bowel probably don't do it because when doing it laproscopically it is like trying to pick up worms with chopsticks. That is why he measured mine outside of my body. I am told that takes about 10 minutes.

In a great many people who fall in the proper range of total SBL where a 100 CM CC + AL roughly equal the total BPL there will be no problem with the cookie cutter DS, but there are going to be many who don't fall into that range. Did he tell you how long he will make the AL? You can estimate your total SBL based off of your height and then figure out if the AL & CC lengths seem appropriate.

I just know how much not doing the Hess Method on me originally has screwed up my life the last 2 years and I don't want to see anybody have to unnecessarily go through that...so my apologies if I am coming on strong in this post. I don't want to see you end up like me or not lose enough.

 

[SJB41976]

@DSRIGGS you aren't coming on too strong. I get what you are saying and if had been through that I would feel the same way.

 

[SJB41976]

None of the US surgeons I contacted included this @SJB41976 They gave me orders for the different specialists I was required to see and it was my responsibility to make the appointments and pay. Even the nutritionists sessions were extra. The fee only included, doc, anesthesia and hospital

So it was all for pre-op testing and you are saying that the nutrition appointments are extra and not included, right?

 

[Clematis]

Yes @SJB41976 this is all pre-op. The nutritionist sessions were in the doctors office but billed separately. Because they were under the same roof, this is the one thing I feel should have been included. If I recall they were $75 a session. Cardiologists, Pulmonologists, Psychologists, Sleep Apnea testing -- all extra.

I contacted 3 local surgeons so hardly a statistically valid sampling of all WLS surgeons in the USA, though. But logic says that each patient will require different specialists pre-op so it would be hard to make it an all-inclusive.

 

[Clematis]

All these ups and extras above an already-sky-high cost, was one of the reasons I went to Mexico, @SJB41976

 

[duh_Mom]

@SJB41976 @ Boyce's - the nutritionist, exercise phiso and any nurse consults are fully covered for 1 year with the self pay. 1800 dollars of the fee covers all that. The additional fees I incurred were from complications - and no not because I was non-compliant. I had part of my AL limb pulled back into the trocar site - probably when the trocar was withdrawn. This is clearly a surgical complication. I returned to surgery 2 days later - and only a miracle kept the bowel from being strangulated to death and rupturing. I did go into shock and required extensive treatment for that. 'bout bought it - did not know how sick I was till I was home about a month and got my brain back.

It is a very rare complication - several of the bariatric long term nurses had never seen that complication.